This document discusses the echocardiographic assessment of atrial septal defects (ASDs). It describes the main types of ASDs and notes that 80% are secundum defects. Echocardiography is used to identify and characterize ASDs, detect associated anomalies, diagnose complications, and guide treatment. Transthoracic echocardiography is the initial study, while transesophageal echocardiography provides better views of the atrial septum. Key measurements include ASD size, location, rim dimensions, and quantifying shunt severity with Qp/Qs. Echocardiography guides decisions about ASD device closure or surgery.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Echo assesment of Aortic Stenosis and Regurgitationdrpraveen1986
A simple ppt presentation on echo assesment of AS and AR. Don forget to leave a comment if u find this ppt useful. - Dr. Praveen Babu, Vijaya HOspital, Chennai
TGA is a complex congenital heart disease.Understanding the anatomy,physiology,surgery and anaesthetic management is very important for patient's better outcome.This ppt explains all these points in detail.
Definition:
Also known as Hypoplastic Right Heart Syndrome (HRHS)
It is a rare congenital cardiac lesion characterized by heterogeneous right ventricular development, an imperforate pulmonary valve, and possible extensive ventriculocoronary connections.
It is a type of congenital cyanotic heart disease, a severe form of Tetralogy of Fallot (TOF)
Newborn patients present cyanotic with high desaturation and pulmonary blood flow that depend on patent ductus arteriosus
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
Fractional Flow Reserve during CAG, Radiofrequency ablation during EP study, Shunt calculation by right heart catheterization, and equation for pulmonary venous resistance
Warfarin and newer oral anticoagulants e.g. debigatran, rivaroxaban, apixaban were presented in cardiology morning session in Bangabandhu Sheikh Mujib Medical University.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
3. Types of ASD
1. ASD secundum
2. ASD primum
3. Sinous venosus
4. Coronary sinus variety
4.
5.
6.
7. 1. 80% secundeum, located in the region of the
fossa ovalis and its surrounding
2. 15% Primum, located near the crux, AV valves
malformed with regurgitation
3. 5% SVC type sinus venosus, defect located near
to SVC, assocaited with anomalous pulmonary
venous return
4. <1% IVC type sinus venosus, defect located near
IVC
5. <1% Unroofed coronary sinus, separation from
the LA partially or completely missing
8.
9. Associations of other…
• Secundum ASD: MVP
• Primum ASD: AV canal defect (Down syndrome)
• Sinus venosus: Partial anomalous pulmonary
venous retrun
• Conornary sinus variety: complete AV septal
defect, absence of coronary sinus, left SVC that
drains into the left atrium
10. Facts about ASD
• Asymptomatic until adulthood
• Symptoms beyond the fourth decade
• Life expectency reduced
• Quality of life decreased
• Eisenmenger rare (<5%)
11. Echocardiography in ASD
• To identify and confirm ASD
• To identify associated anomalies
• To diagnose complications of ASD
• For therapeutic purpose
16. Common views in TTE
• Subxiphoid Frontal (Four-Chamber)
• Subxiphoid Sagittal
• Left Anterior Oblique
• Apical Four-Chamber
• Modified Apical Four-Chamber
• Parasternal Short-Axis
• High Right Parasternal View
17. TTE views for ASD
• Subxiphoid Frontal (Four-Chamber)
The subxiphoid frontal (four-chamber) view
allows imaging of the atrial septum along its
anterior–posterior axis from the SVC to the
AV valves.
18.
19.
20. • Subxiphoid Sagittal
The subxiphoid sagittal TTE view is acquired by
turning the transducer 90 clockwise from the
frontal view. This view can be used to measure
the rim from the defect to the SVC and IVC
and is an excellent window to image a sinus
venosus type defect
21.
22.
23. • Apical Four-Chamber :
This view is used to assess the hemodynamic
consequences of ASDs, such as RA and RV
dilation, and to estimate RV pressure using
the tricuspid valve regurgitant jet velocity. This
view is also used to evaluate for right-to-left
shunting with agitated saline
24.
25.
26. • Parasternal Short-Axis
This view is ideal to identify the aortic rim of the
defect. It also highlights the posterior rim (or
lack thereof) in sinus venosus and
posteroinferior secundum defects.
27.
28. • Left Anterior Oblique.
The left anterior oblique is acquired by turning
the transducer approximately 45
counterclockwise from the frontal (four-
chamber) view. This view allows imaging of
the length of the atrial septum and is
therefore ideal to identify ostium primum
ASDs and for assessment of coronary sinus
dilation
29.
30.
31.
32.
33. • Modified Apical Four-Chamber
(Half Way in Between Apical Four-Chamber and
Parasternal Short-Axis View):
In the patients in whom the subcostal views are
difficult to obtain, the modified apical four-
chamber view is an alternative method for
imaging the atrial septum
34. • High Right Parasternal View.
The high right parasternal view is a parasagittal
view performed with the patient in the right
lateral decubitus position with the probe in
the superior–inferior orientation. In this view,
the atrial septum is aligned perpendicular to
the beam and is ideal for diagnosing sinus
venosus defects, particularly when the
subxiphoid windows are inadequate
35. ASD secundum rims
• SVC or superior margin
• IVC or inferior margin
• Posterior margin
• Anterior or retroaortic
margin
• Mitral rim
36. Views to identify the ASD rims
PSAX view at great vessel level:
Aortic and Post rim
A4CV:
Mitral Rim
Subcostal view: SVC and IVC rim
43. ASD with Eisenmenger syndrome
• pulmonary hypertension,
• reversal of flow,
• and cyanosis
44.
45.
46. ASD secundum Device closure
CRITERIA:
1. “Significant” ASDs (Qp/Qs >1.5 or ASDs associated with right
ventricular volume overload) should be closed
2. Secundum ASD that has a stretched
diameter of less than 38 mm and more than 10 mm
3. Adequate rims (5 mm) to enable secure
deployment of the device
4. Anomalous pulmonary venous connection
or proximity of the defect to the AV valves or coronary sinus
or systemic venous drainag, intracardiac thrombie absent
49. Follow up echo after device closure
After device closure, patients require 6 months of aspirin and
endocarditis prophylaxis until the device endothelializes,
following which, assuming that no residual shunt is present
all patients who have undergone device closure should
probably have an echocardiogram taken every 5 years or so
because of the possibility of late issues, especially
erosion.
Ref: Braunwald 10th ed
